Saha, Arunava, Balakrishnan, Suryanarayanan, Trivedi, Nitin et al. · AACE clinical case reports · 2023 · DOI
This case report describes a woman with chronic fatigue syndrome who accidentally poisoned herself by swallowing topical hydrocortisone cream as a replacement for prescription prednisone. She developed dangerously high blood pressure and a severe drop in potassium levels, which can cause life-threatening heart problems. The key lesson is that over-the-counter medications can cause serious harm if used incorrectly, even when applied to skin.
ME/CFS patients often experience medication management challenges and may self-adjust treatments when experiencing worsening symptoms. This case illustrates how even seemingly benign over-the-counter products can cause life-threatening complications when misused, highlighting the importance of patient education and careful medication counseling in vulnerable populations.
This single case report does not establish the incidence or prevalence of hydrocortisone cream toxicity in any population. It does not prove that ME/CFS patients are more susceptible to corticosteroid toxicity than others, nor does it establish causation between ME/CFS and poor medication decisions—the patient's actions resulted from discontinuation of prescribed therapy without medical supervision.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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